{include file="$g_template/_fronthead.tpl"}

<div id="wrap_5">
		<div id="header">
			<div class="logo"><img src="{$g_image}/logo.png"></div>
			<div class="welcome"><img src="{$g_image}/welcome.png"></div>
		</div>
        
        {include file="$g_template/_mainmenu.tpl"}
        
	<div id="web_content">
		<div class="title_content">Pre-authorize</div> 
		<div class="line"></div>
		<div class="text_description">
			<p>&nbsp;</p>
			<p style="margin-top:5px;">กรุณากรอกข้อมูล <span class="text_red">เลขบัตรประชาชน</span></p>
		</div>
		<div class="search">
			<div class="form_search">
				<table width="600" border="0" align="center" cellpadding="1" cellspacing="1"">
					<tr>
						<td colspan="3" height="60" align="center">&nbsp;</td>
					</tr>
					<tr>
						<td width="40%" align="right"><span class="text_red_bold">* บริษัทประกัน :</span> </td>
						<td width="27%" align="left"><!-- <input type="text" name="txt_insure" id="txt_insure" style="widht:150px;"> -->
							<select id="fund" name=fund>
								{foreach from=$data item=item}
		                        	<option value={$item.fund_id}>{$item.thainame}</option>
		                         {/foreach}
							</select>
						</td>
						<td width="33%"> </td>
					</tr>
					<tr>
						<td colspan="3" align="center">&nbsp;</td>
					</tr>
					<tr>
						<td align="right"><span class="text_red_bold">* เลขบัตรประชาชน :</span> </td>
						<td align="left"><input type="text" name="txt_idcard" id="txt_idcard" style="widht:150px;"></td>
						<td > </td>
					</tr>
					<tr>
						<td colspan="3" align="center">&nbsp;</td>
					</tr>
					<tr>
						<td colspan="3" align="center">&nbsp;</td>
					</tr>
					<tr>
						<td>&nbsp;</td>
						<td align="center">
							<!-- <img src="{$g_image}/button/btn_search_1.png" width="80" height="36" border="0"  
							onMouseOver="this.src='{$g_image}/button/btn_search_2.png';" 
							onMouseOut="this.src='{$g_image}/button/btn_search_1.png';"> 
							<input type="button" name="btn_submit" value="ค้นหา" style="width:130px; height: 30px; font-size: 16px;" onclick="popUpWindow('{$APP_URL}/testpopup','search',1280,452,'yes');" >-->
							<input type="button" id="btn_preauth_fund" name="btn_preauth_fund" value="ค้นหา" style="width:130px; height: 30px; font-size: 16px;" onclick="_renderPreauthListByIDCard();">
							<a id="link_preauth_fund"></a>
						</td>
						<td align="right">&nbsp;</td>
					</tr>
				</table>
			</div>
		</div>
	</div>
{include file="$g_template/_frontfoot.tpl"}